Manic Minds: Mania's Mad History and Its Neuro-Future 9780813552033

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Manic Minds 

Manic Minds  Mania’s Mad History and Its Neuro-Future

lisa m. hermsen

rutgers university press new brunswick, new jersey, and london

Library of Congress Cataloging-in-Publication Data Hermsen, Lisa M., 1968– Manic minds : mania’s mad history and its neuro-future / Lisa M. Hermsen. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8135-5157-9 (hardcover : alk. paper) — ISBN 978-0-8135-5158-6 (pbk. : alk. paper) 1. Manic-depressive illness—History. 2. Neuropsychiatry— History. I. Title. [DNLM: 1. Bipolar Disorder—history. 2. Bipolar Disorder—etiology. 3. Bipolar Disorder—therapy. 4. Neuropsychiatry—methods. 5. Psychiatry—history. WM 207] RC516.H47 2011 616.895—dc22 2011010852 A British Cataloging-in-Publication record for this book is available from the British Library. Copyright © 2011 by Lisa M. Hermsen All rights reserved No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, or by any information storage and retrieval system, without written permission from the publisher. Please contact Rutgers University Press, 100 Joyce Kilmer Avenue, Piscataway, NJ 08854–8099. The only exception to this prohibition is “fair use” as defined by U.S. copyright law. Visit our Web site: http://rutgerspress.rutgers.edu Manufactured in the United States of America

For my family, for sharing their very real special powers

CONTENTS

List of Figures ix Preface and Acknowledgments

xi

Introduction: Mania’s Mad History and Its Neuro-Future 1 1

Mania Multiplies with Fury: Textbook Descriptions of the Psychopathology 13

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The Maniac and the Iconography of Reform

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Midwestern Mania: Genetics in the Heartland

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Manic Lives: Mad Memoirs

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Neuropsychiatry, Pharmacology, and Imaging the New Mania 98 Epilogue: A Mad, Mad World Notes 123 Bibliography Index 147

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LIST OF FIGURES

I.1. 1.1. 1.2. 1.3. 2.1. 2.2. 3.1. 3.2. 5.1. 5.2. 5.3. 5.4.

Madness, 1806 “The Dancing Mania,” 1564 “Esquirol’s Patient,” circa 1830 Self-decorated manic patient, 1907 Dr. Philippe Pinel at the Salpêtrière, 1795 Hospital for the Insane, Philadelphia, 1841 Pedigree chart of the C___ family, 1911 Manic depressus, circa 1922 “The Brain: the Cerebral Cortex,” 1537 “Head and Brain of Adult Human Head, MRI” “Straitjacket,” 1838 Frier Hospital, London, a woman suffering from mania, 1890

3 17 22 27 38 57 70 71 106 107 108 109

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PREFACE AND ACKNOWLEDGMENTS

When Larry King interviewed Terminator star Linda Hamilton on CNN’s Larry King Live in 2005, he described her as living “a private hell that drove her to drugs, hallucinations, and violent rages.” On the show, he promised, she would reveal “how she escaped bipolar disorder, the horror that torments millions.” “Hell,” “violence,” “rages,” “horror,” “torment”—words like these would dominate my writing and research for the next five years. I began writing this book on a tour of Philadelphia, when on the advice of a friend I headed to the archive of the Mütter Museum of the College of Physicians. The archivist there shared with me one of the most valuable pieces of paper I own, the handwritten documentation of a case in which a doctor wrote about a patient who was treated by blistering and bleeding but who nevertheless died of a furious mania. This case is still a valuable possession, a reminder of where this book started, even without my knowing it yet. As this book developed, I was inspired and supported by a network of institutions in Philadelphia. I must begin my acknowledgments with The Library Company of Philadelphia, one of the oldest institutions in the nation and now a kind of second home to me; a very gracious thank-you to James Green for his hospitality there. The Library Company awarded me a fellowship in the Program in Early American Medicine, Science, and Society, allowing me to work closely with many valuable resources. I thank Connie King for her patience as I returned regularly, requesting asylum report after asylum report (well over a hundred in all). I also thank Charles Rosenberg for amassing such a collection and for donating it to The Library Company. Too, I thank Stacey Peeples at the Philadelphia Hospital for allowing me to invade her space one afternoon and read nearly all the hospital’s early admission records. While Philadelphia provided a nexus for my research, a rich source of texts exists in the city where I live, Rochester, New York, at the Miner Library, whose rare-book collection includes first editions of most major psychiatric textbooks. xi

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preface and acknowledgments

Christopher Hoolihan was able to find nearly everything I asked for, and started to intuit what I might want and need. He even translated a few lines of Latin. The book certainly would not have been possible without the regular Tuesday afternoons I spent at the Miner. As for research assistance, I can’t say enough good things about Alison Whalen, president of the local Depression and Bipolar Support Alliance/Parents of Bipolar Children/Youth, who works tirelessly with and for parents and their children. Thank you for allowing me to just listen. I received much advice while completing the manuscript. I want to thank Deb Blizzard, in particular, for talking with me over coffee, suggesting an approach to the introduction, and pointing me to sources. I gratefully recognize Rochester Institute of Technology for its support in the form of a very valuable Miller Fellowship and for various travel and research grants. I especially thank the former chair of my department, Richard Santana, for protecting as much of my time as he could and for asking about my progress always. For beginning the publication process with me as editor at Rutgers University Press and adding her editorial comments to the first two chapters of the book, I thank Doreen Valentine. Her work played a role in developing the remaining chapters. For profoundly improving this manuscript, I gratefully acknowledge Audra Wolf, whose sound editorial advice was sometimes tough but always on the mark. Her encouragement was equally essential. I appreciate her close and timely reading, the several long phone calls, and an invitation to tea. I thank Peter Mickulas, who pushed me to finish the writing, let go of the manuscript, and allow someone else to read it. Thank you to Bryce Schimanski, in particular, for moving the book through the last stages of manuscript preparation. Finally, for close editing of difficult passages, thanks to Bobbe Needham. When asked why I chose to write this book, I rarely dare to reveal my own experiences with mania. By emerging from this diagnostic silence, however, I am able to tell a story beyond my own limited narrative. There were certainly times during the writing when I had to come to terms with the debilitating effects of a manic episode—the bodily reality of psychic tension, times when linguistic power eluded me. But in the end, I hope to have written with the confidence and credibility of one who possesses a dynamic relationship to mania. A special group of people has been more than friends: Jess, Amit, Laura, and Tim have lived my manias with me (and entertained backyard tackle bocce with a competitive spirit). I am so very thankful to this group of people. I owe them more than I can express. Friends who invited me to yoga until I finished this book: you rock. I thank Rebecca and Dave for opening their den and inviting us in. To my colleagues who never doubted this book would finally be finished, thank you for believing. For their advocacy and constant work at helping me live without significant episodes of mania during the course of what was an emotional process, I am

preface and acknowledgments

xiii

grateful to my professional supporters: my psychiatrist, Dr. L—, my psychotherapist, Dr. C—, and my favorite yoga instructor, Amanda. My parents visited when I needed to take a break, and they came to see me when I was struggling. They fixed lamps, did laundry, oiled squeaky doors—all while I sat at my desk stuck on a single sentence. They took me on long meandering walks through the park because they knew I was scared. My sisters texted and phoned and put my life in perspective. This project has both excited and aggravated me over the last several years, and it was my family particularly who helped me sustain my sanity. Thanks to them all for giving me devoted support—and for being willing to do so twenty-four hours a day. My husband, Rich, got me into this project by bringing me to The Library Company on our first romantic weekend away together. While he introduced me to the joy of good sushi, he also introduced me to the joy of a good archive. Since my first find that weekend, he has been nothing but encouraging. He had not yet seen the torrent of my moods then, but he does not love me any less now that he has. His truly grand gesture, a move from his home in Buffalo, New York, to our home together in Rochester, likely saved me and the manuscript. Because he always works with me to search for the right words, I am unspeakably thankful.

Manic Minds 



Introduction mania’s mad history and its neuro-future Toward the close of the [eighteenth] century, mania still wore its earlier garb. —Andrew Scull, Social Order/Mental Disorder

I showed up for my intake interview on Halloween 2003 as an obvious, almost clichéd, figure of madness. I had been performing a kind of madness in various ways for years with deliberate imprecision. I wasn’t actually crazy all the time or everywhere. There was little clarity or rigor—no method to my madness. Nevertheless, I had shown up for this interview wearing my Halloween costume: the black widow with fishnet stockings, shoes with heels meant more for seduction than mourning, a nearly too-short black velvet skirt, a gossamer top, long black silk gloves, a black wedding veil, and a large fake diamond ring. The only clue to the essence of the costume—a tasteful sterling pin in the form of a spider. I met the messy questions about impulsive behaviors, excessive spending or sexual activity, and suicide intention or ideation with extrapolated and rambling attempts to give honest but elusive responses. I explained vehemently that my fantasies were not of suicide, exactly. I did not want to kill my self, just my brain. I urgently needed to stop it. I described a fantasy more imaginative than any mere suicide attempt, a scene in which I clawed at the skin at the back of my neck until layers of muscle fell to pieces, so that I could grab hold of my spinal cord and wrench the entire system—brain and every connected nerve ending—out of whatever would be left of my body. I left the office diagnosed with a manic disorder and prescribed the pharmaceutical cure, lithium. I did not recognize myself as a mad woman or a maniac. In fact, I’m told it is best not even to think of myself as bipolar. I have an abnormal neurotransmitter system. To be more precise, I have irregularity in my protein kinase C (PKC) signaling system, increase in my dopamine and noradrenaline neurotransmission, 1

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manic minds

and dysfunction in at least two discrete brain structures (the orbitofrontal and medial frontal cortex). These abnormalities had assembled in my brain and were embodied as a piercing, profoundly strange invisible but pervasive pain. The task of accurately describing my mania is wholly unsatisfying. Neither eccentric memoir nor clinical terminology can provide all that is necessary for a suitable appreciation. My mania is a raging fury and a dysregulated neurotransmission with an enduring (partial) connection to madness at its intersection with a potential neurofuture.

Mania’s Mad History From classical to nineteenth-century psychiatry, “mania” described a general category of insanity and could be used interchangeably with such words as “lunacy” or “insanity” to characterize the agitated, furious, and sometimes rageful insane. But while “madness” and “lunacy” have, for the most part, disappeared from contemporary clinical discourse, “mania” remains in use in the clinical psychiatric vocabulary. To put it mildly, then, in the contemporary diagnosis of mania as mental illness, the maniac has occupied “a wholly unenviable ontological status”1—the iconic figure chained in an asylum cell (see figure I.1). Prominent medical historian German Berrios, however, has argued that no plausible history of mania can be written. He warns against reading the mania of the past through the lens of the present. He has rightfully noted that what might have been named “mania” in the first century bears little relation to the disorder classified today as bipolar and to the defining manic episodes. Berrios has wondered, in fact, whether historical examinations of mania provide more than merely a history of a word.2 I argue that the word matters, and that a rhetorical history of mania, no matter how messy, can be written—one that pays close attention to the layers of description that have framed mania from classical Greek medicine onward. Indeed, I show that even twenty-first-century definitions of madness remain steeped in the “pertinent words” of psychiatry’s earliest practitioners. In this rhetorical history, semantic content and linguistic translations carry the residue of concepts that have been regularly connected over time. Since Hippocrates, mania has been described as excitement, with fury or anger as the primary distinguishing emotion. The International Neuropsychological Society refers to the Greek etymology of “mania” in its dictionary as “madness, from mainesthai, to rage.”3 Even as language has shifted and changed, meanings and concepts converge. My book is important because it illustrates how mania has always persisted as multiple objects, often enacted at the same time. Aretaeus of Cappadocia (150–200 CE), in Chronic Diseases, provides the earliest authoritative description of mania as a condition marked by excess: If mania is associated with joy, the patient may laugh, play, dance night and day, and go to the market crowned, as if victor in some contest of skill. If it is

introduction

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